celiac diseae, sprue, whipple etc

Question 1

What is celiac disease?

Answer 1

immune mediated damage of small bowel villi

hypersenstivity type 4 rxn as a result of gluten exposure

Question 2

What HLAs are associated with celiac?

Answer 2

HLA DQ2 and 8

Question 3

What is the most pathogenic form of gluten?

Answer 3

gliadin

Question 4

What are the clinical presentations of celiac disease in adults and children?

Answer 4

children - growth retardation, abd distension, diarrhea

adults - chronic diarrhea and bloating

Question 5

What skin condition is associated with celiac disease? why?

Answer 5

dermatitis herpetiformis - IgA deposition at dermal papillae

Question 6

What igA antibodies can be found in celiac disease?

Answer 6

against:

• endomysium
• tTG
• Gliadin

Question 7

If someone with celiac disease is IgA deficient how can you tell?

Answer 7

presence of igG antibodies instead of igA

Question 8

What is the pathological appearance of celiac disease?

Answer 8

flattening of villi, hyperplasia of crypts

intraepithelial lymphocytes

Question 9

Where in the small bowel does celiac disease tend to affect?

Answer 9

duodenum

Question 10

Symptoms of celiac disease usually dissapear with a gluten free diet, if this is not the case, what complications can occur?

Answer 10

enteropathy associated T cell lymphoma

small bowel carcinoma

Question 11

What is tropical sprue?

Answer 11

damage to small bowel villi due to unknown organism

Question 12

What are 3 ways celiac disease and tropical sprue differ?

Answer 12

Tropical sprue:

• tropical regions
• arises after infectious diarrhea and responds to antibiotics
• damage mostly in jejunum and ileum

Question 13

Since damage in tropical sprue disease is in the jejunum and ileum, what temporary malabsorption issues could you see?

Answer 13

folic acid and vit B 12 deficiency

Question 14

What is the classic site of infection of T whippeli?

Answer 14

small bowel lamina propria

Question 15

What is the pathogenesis of T whippeli?

Answer 15

infiltration of mucosa with macros

Question 16

What clinical features occur in whipple disease?

Answer 16

malabsorption and steatorrhea - compression of lacteals by macros
CAN:
-Cardiac
-arthralgia
-neuro

Question 17

What is abetalipoproteinemia?

Answer 17

auto recessive deficiency of apoB48 and B100

• malabsorption - can’t form chylos - B48
• absent plasma VLDL, LDL -B100

Question 18

What is the most common cause of infantile diarrhea?

Answer 18

rotavirus

Question 19

Where does the norwalk virus tend to infect? What is seen pathologically?

Answer 19

upper small intestine

patchy mucosal lesions and malabsorption